title: Effect of a very low-protein diet on outcomes: long-term follow-up of the Modification of Diet in Renal Disease (MDRD) Study.
abstract: BACKGROUND
  The long-term effect of a very low-protein diet on the progression of kidney disease is unknown. We examined the effect of a very low-protein diet on the development of kidney failure and death during long-term follow-up of the Modification of Diet in Renal Disease (MDRD) Study.
  
  
  METHODS
  Long-term follow-up of study B of the MDRD Study (1989-1993).
  
  
  METHODS
  The MDRD Study examined the effects of dietary protein restriction and blood pressure control on progression of kidney disease. This analysis includes 255 trial participants with predominantly stage 4 nondiabetic chronic kidney disease.
  
  
  METHODS
  A low-protein diet (0.58 g/kg/d) versus a very low-protein diet (0.28 g/kg/d) supplemented with a mixture of essential keto acids and amino acids (0.28 g/kg/d).
  
  
  RESULTS
  Kidney failure (initiation of dialysis therapy or transplantation) and all-cause mortality until December 31, 2000.
  
  
  RESULTS
  Kidney failure developed in 227 (89%) participants, 79 (30.9%) died, and 244 (95.7%) reached the composite outcome of either kidney failure or death. Median duration of follow-up until kidney failure, death, or administrative censoring was 3.2 years, and median time to death was 10.6 years. In the low-protein group, 117 (90.7%) participants developed kidney failure, 30 (23.3%) died, and 124 (96.1%) reached the composite outcome. In the very low-protein group, 110 (87.3%) participants developed kidney failure, 49 (38.9%) died, and 120 (95.2%) reached the composite outcome. After adjustment for a priori-specified covariates, hazard ratios were 0.83 (95% confidence interval, 0.62 to 1.12) for kidney failure, 1.92 (95% confidence interval, 1.15 to 3.20) for death, and 0.89 (95% confidence interval, 0.67 to 1.18) for the composite outcome in the very low-protein diet group compared with the low-protein diet group.
  
  
  CONCLUSIONS
  Lack of dietary protein measurements during follow-up.
  
  
  CONCLUSIONS
  In long-term follow-up of the MDRD Study, assignment to a very low-protein diet did not delay progression to kidney failure, but appeared to increase the risk of death.
authors.affiliation: Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, MA, USA.
authors.forename: Vandana
authors.initials: V
authors.lastname: Menon
authors.forename: Joel D
authors.initials: JD
authors.lastname: Kopple
authors.forename: Xuelei
authors.initials: X
authors.lastname: Wang
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Beck
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Collins
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Levey
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
mesh_terms: D000328:Adult; D000596:Amino Acids / Q000008:administration & dosage; D002908:Chronic Disease; D018753:Diet, Protein-Restricted; D019587:Dietary Supplements; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007651:Keto Acids / Q000008:administration & dosage; D007674:Kidney Diseases / Q000178:diet therapy*; D008297:Male; D016032:Randomized Controlled Trials as Topic; D051437:Renal Insufficiency / Q000401:mortality / Q000517:prevention & control; D016019:Survival Analysis
chemical_list: D000596:Amino Acids; D007651:Keto Acids